title: A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace.
abstract: BACKGROUND
  Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer's perspective.
  
  
  METHODS
  Employees used a 'loyalty card' to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates.
  
  
  RESULTS
  The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.
  
  
  CONCLUSIONS
  The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer's perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable "business model" which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges.
authors.affiliation: Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences B, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, UK. mdallat01@qub.ac.uk.
authors.forename: Mary Anne T
authors.initials: MA
authors.lastname: Dallat
authors.forename: Ruth F
authors.initials: RF
authors.lastname: Hunter
authors.forename: Mark A
authors.initials: MA
authors.lastname: Tully
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Cairns
authors.forename: Frank
authors.initials: F
authors.lastname: Kee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D015438:Health Behavior; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009786:Occupational Health Services; D012201:Reward; D017132:Workplace